A family with extrinsic allergic alveolitis caused by wild city pigeons: Acase report

We describe a family in which the mother died of unresolved lung disease an d whose 5 children, some of whom had previous signs of asthma, were subsequ ently affected by extrinsic allergic alveolitis caused by contact with wild city pigeon antigens. The children received systemic corticosteroids for 1 month and inhaled steroids for 24 months, while antigen exposure was reduc ed as much as feasible. This was followed by a quick clinical recovery and a slow normalization of chest radiographs and pulmonary function indices, e specially of diffusion capacity, during a follow-up of 24 months. Because pigeon-breeder's lung caused by free-roaming city pigeons has not b een previously described, it remains unclear whether this family developed the disease because of high antigen exposure or because of increased suscep tibility. None of the supposedly high-risk human leukocyte antigen types we re found in the children. Whether human leukocyte antigen B7 in 1 child pla yed a role in the course of the illness remains speculative. It is unknown to what extent pigeon-breeder's lung caused by nondomestic birds remains un detected and misdiagnosed as difficult or steroid-resistant asthma. The que stion remains whether free-roaming city pigeons are indeed a public health risk. We suggest that atypical outdoor antigens be considered in all patien ts with nonresolving chest disease or therapy-resistant asthma.